The Road Ahead

Revolutionising Healthcare

An in depth discussion with Dr. Masoud Afnan,

General Manager of Tianjin United Family Healthcare

By Oshani Silva

With the healthcare undergoing a large overhaul recently it has become a much talked about topic. This month we sit down with esteemed Dr. Afnan, the General Manager of Tianjin United Family Hospital to talk in depth about how United Family Healthcare is revolutionising the approach to health care in China one city at a time.

Born in Ethiopia and brought up in England, Dr. Afnan graduated as a doctor in 1980 from the University Of London Charing Cross Hospital Medical School. With 30 years of experience as an obstetrician and gynaecologist, he has made numerous contributions to the British Royal College of Obstetricians and Gynaecologists (RCOG), The Human Fertilization and Embryology Authority (HFEA) and the British Fertility Society.

How did you come to your position at Tianjin United Family Healthcare (TUFH)?

I joined UFH in 2010. From 2010 to 2012, I was the Chair of the Obstetrician and Gynaecology Department at Beijing United Family hospital, following which I served as the Chief Medical Officer at the same hospital from 2013 to 2015.

Acting as a Doctor and General Manager is no easy task. Which aspect of your job do you find more challenging, the healthcare or financial management aspect?

As a doctor, the reason why I am in healthcare management is to improve the health of people. When you go to management meetings all you see is numbers. Clearly we have to make money, we have to reach our targets, we have to satisfy our investors and there is pressure to meet those targets. But what we don't have yet generally in healthcare, and we are working very hard to do, is to measure the health outcomes. That is quite a difficult task. When you go to the doctor, the normal lay individual will not know if the doctor actually helped him or not. You might have got better anyway. Maybe they could've given you another medicine that would've been better. Unless we can measure these outcomes we will never know that we as doctors are doing any good. My mission whilst I'm here in Tianjin is to put health outcome measurements on the agenda so that we also can measure how we have improved the health of our patients.

TUFH provides a wide range of healthcare services. Could you summarise them for our readers?

We focus on a number of areas for women and children. I like to include husbands in that area as well. Obstetrics and paediatrics are the foundation of all the services that we provide. We also provide IVF (in vitro fertilization) and fertility treatments. This is new to United Family. This is my field of professional expertise. I believe that in collaboration with other clinics in Tianjin, we will make Tianjin a world class centre for IVF.

Primary care is another area of focus. The purpose of primary care is to have a well-trained general doctor look after most of the health needs of the people. In UK, 90% of care is delivered by general practitioners. It is a very cost effective approach and solution. The care of patients needs to be well coordinated in order to provide affordable, cost effective care, which we want to be able to make available for everybody.

What specialties are not covered yet and what services do you wish to add in future?

The primary care concept is something we want to develop on a large scale. Our main focus is the patient. Our primary care doctors are able to care for patients who need prevention and screening for disease, for caring for patients with long term chronic conditions, and for most common acute conditions. Mos importantly, when they can recognise when a patient needs to see a specialist and ensure timely appropriate referrals to specialists within our system or in local hospitals.

There are a few areas that I think in 10 years' time will change with regards to medicine in general, and in China in particular, an example being that of clinical genetics. With a few drops of blood you can analyse your genome for a very low cost. The problem of doing that is that nobody knows what it means, nobody can interpret it and there is a real risk of over interpretation. In my opinion there is a need for a clinical genetics department to interpret these genetic results so that when the problems arise they can advise patients in advance on the risks and how to prevent disease. I think that is an aspect which is not well developed here in China so we would like to focus on these areas that are currently not well represented. We want to offer something different to our patients.

What sets Tianjin United Family Healthcare apart from the other private healthcare centres and hospitals in Tianjin?

United Family Hospital has always done very well with patient experience. Patient experience is very different from patient satisfaction. Patient satisfaction might be the doctor giving his or her signature on a prescription or sick note as requested by the patient. Patient satisfaction then becomes a 10/10. That is not right. There is even evidence to suggest that this leads to higher mortality rates.

What should be done is that we take the time with the patient, check their understanding with regards to the illness and treatment, give them written documentation, explain everything and involve the patient in the decision making process. We fully explain to the patient the treatment process including the chances of potential side effects from drugs. This level of discussion and understanding takes time and that's what we offer very well at TJU.

Healthcare has become very financially competitive with rapid economic development taking place in China. With standards of care and quality of hospice care increasing rapidly, how do you maintain your superiority amongst your competitors?

Staying ahead of competition has many aspects. At the core of it is to make sure we offer very high quality services and then the patients will come. One of the problems all over the world, and in China is that there is a lot of over treatment. For an example: two tablets are thought to be better than one, but that's not the case. We want to provide evidence based practice. Europe went through this revolution 20-30 years ago. Providing evidence based practice has two main benefits. It honestly tells the patient pros, cons, risk and benefits. It also stops wastage of money.

When people go for a health check-up, they feel like the more tests you do the better it will be for you. But that's not the case because the usefulness of screening tests depends on how common the condition is. If it's very rare, it wastes money. Instead of chasing down real problems you start chasing down false problems and that is harmful to patients.

In America they did a study to work out the cause of death. They found that medical error, be it in testing, procedures or operations was the third highest cause of death after cancer and heart disease. Therefore having the approach of providing evidence based, high quality medicine across everything will help us to stay ahead.

United Family Healthcare has been a company doing business exclusively in China for a few decades now. Are there plans to extend the healthcare to other countries or territories within China?

Yes we are always planning to open hospitals in China. We just opened a hospital in Qingdao and will open a hospital in the coming months in Guangzhou. We are looking at other sites too so that every few years we will be opening a new hospital. In addition we have satellite clinics. This is something we have done successfully in Beijing and Shanghai. Our aim is to reach out into the community, so we have plans to open more satellite clinics.

With 46 highly trained clinicians including 5 internationally trained doctors and 14 departments, United Family Health Care has a comprehensive health care setup. It has become a highly reputed healthcare establishment in Tianjin. What are the steps taken by your company to increase the market share?

I think this whole approach of openness, transparency and honesty with the patient is very well established in the West. Before I came to China the patient would come and see me and I would immediately provide that patient with a full written summary of the appointment. The advantage of that is that the patient gets a full written summary of their care because most of us forget half of what the doctor tells us. Having written records will help us measure the outcomes. What I would love to do and am in the process of implementing is measuring these outcomes and sharing them with our patients. This information I think will be a key factor in increasing market share.

You have been a model for premium western style treatment and healthcare here in China, how has the response of the locals been and have you had to adjust with regards to the market circumstances?

The pressures are the same in China as in any other part of the world. In some aspects the pressures are present to a higher degree especially with regards to children. In the West if a child catches the flu, usually the parents will watch the child and maybe give them some simple medicines. In China however they generally want to go see their doctor. Keeping these cultural differences in mind we've made adjustments. The important point in such instances is to make sure to provide high quality evidence based medicine and not just provide care because of parent expectations. In these situations with minor illnesses often it is better to not give medicine at all. However this should done after a good discussion with the parents and it is important to make sure that the parents are well informed.

What are your future plans to further develop the healthcare system at TJU?

Our future plans are focused on two main areas including primary care and IVF. With regards to primary care, our top priority is to provide community care services to thousands of residents in Hexi District. We would like to see an increase in our numbers in IVF cycles because I think Tianjin has the potential to be a world class centre for IVF and fertility treatment.

How do you see the future of private healthcare in China?

The West has made a lot of mistakes in developing health care. China doesn't need to make those same mistakes. China can develop its health care well by taking the best of what's on offer around the world and provide it for its citizens. If you look at the American health care system which many Chinese look to as being the ideal model, the American health care system is not as good because it just encourages more activity and less attention is given to quality and outcome of care. At TJU we focus not on doing more activity but actually spending time on patients and their needs, seeing how we can provide for their needs, measurably improve their experience and their health, within a set budget. This greatly changes the incentives from doing unnecessary services, to improving the health of that patient, thereby adding value to the patient experience.

You are Tianjin's top executive of the leading private healthcare institution in China. What is your next challenge?

My next challenge is to make real success of my time here in Tianjin United Healthcare. I've only just started, I've been in Tianjin for 6 months and it takes a while to fully settle into the job. I really enjoy the time I spend here as I think Tianjin is a wonderful city to live in. My goal is to make TJU the focal point of health care for the community around it within the next 3 years. Another goal I hope to achieve is to make the Tianjin and the TJU IVF centre internationally renowned. That to me would be an amazing success.

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